INVITED ESSAY - SEX BIASES IN THE DIAGNOSIS OF PERSONALITY-DISORDERS

One of the more difficult issues in the development of each edition of the American Psychiatric Association's Diagnostic and Statistical Man ual of Mental Disorders (DSM) has been a possible sex bias in the pers onality disorder diagnoses, A substantial amount of discussion and res earch on this issue has occurred since the 1980 publication of the thi rd edition of the DSM, It is now apparent that there are a number of d ifferent ways in which the differential sex prevalence rates for the D SM-IV personality disorders could reflect a sex bias, including biased diagnostic constructs, biased thresholds for diagnosis, biased popula tion sampling, biased application of diagnostic criteria, biased instr uments of assessment, and biased diagnostic criteria. It is important to understand these different forms of sex bias, as each can occur ind ependently of, be confused with, and interact with one another. The pu rpose of this paper is to differentiate among, and to describe the sup port for, each of these different forms of sex bias, with the hope of contributing to their recognition and ultimate resolution.